Polycystic ovary syndrome: Studies of affective symptoms in association with sex steroids and evaluation of electroacupuncture and physical exercise

Polycystic ovary syndrome (PCOS) is a common heterogeneous condition in women of reproductive age, relating to both physical and mental health. Thoughts on primary pathological origins shift from the ovary to the adrenal gland. Insulin signaling pathways and sympathetic nerve activity are thought to be involved. PCOS features include signs of high androgen concentrations and oligo/amenorrhea. Affective symptoms such as depression and anxiety are prevalent among women with the syndrome and have been associated with body mass index (BMI). PCOS interventions are symptom-oriented and should include physical exercise as part of lifestyle management. Effective pharmacological interventions have side-effects to be taken in consideration. Previous studies suggest electroacupunture (EA) to modulate features commonly observed in women with PCOS. The general aims of this thesis were to explore self-reported depression and anxiety-related symptoms in women with PCOS; and to evaluate low-frequency EA and physical exercise on muscle sympathetic nerve activity (MSNA), biochemical hyperandrogenism and oligo/amenorrhea. Study I investigated depression and anxiety-related symptoms in women with PCOS and noted several anxiety symptoms to distinguish women with PCOS from controls matched on age, body weight and BMI. Symptoms of worry, phobias and sleep disturbances were overrepresented among women with PCOS and may be an indication of an increased arousal. Study II explored associations between depression and anxiety symptoms, and estrogens, sex steroid precursors, androgens, glucuronidated androgen metabolites, sex hormone-binding globulin (SHBG) and insulin sensitivity in drug-naïve women with PCOS. Women with depression-related symptoms had lower testosterone (T), free testosterone (FT) and androstane-3α 17β-diol-3glucuronide (3G). There were inverse associations between circulating FT, 3G and symptoms of depression. Study III aimed to evaluate low-frequency EA and physical exercise on MSNA in women with PCOS. Twenty women with PCOS were allocated to low-frequency EA, physical exercise, or no intervention. From baseline to week 16, MSNA burst frequency decreased by -39.4% for low-frequency EA; -39.0 % for physical exercise; and -8.7% for no intervention. Study IV investigated if low-frequency EA would decrease hyperandrogenism and improve oligo/amenorrhea more effectively than physical exercise or no active intervention in women with PCOS. Eighty four women with PCOS were randomized to 16 weeks of low-frequency EA, physical exercise, or no intervention. Circulating T, androsterone glucuronide (ADT-G) and 3G decreased from baseline measurements to week 16 for low-frequency EA compared to physical exercise. Circulating T, FT, estrone-sulfate (E1-S), ADT-G, 3G and androstane-3α 17β-diol-17glucuronide (17G) decreased from baseline measurements to week 16 for low-frequency EA compared to no intervention. The monthly menstrual bleeding frequency increased for low-frequency EA compared to physical exercise and no intervention from baseline measurements to week 16. Conclusions: This thesis supports the effects of low-frequency EA and physical exercise to be partly mediated via the sympathetic nervous system. Low-frequency EA may be a complement for treatment of hyperandrogenism in women with PCOS. With few minor adverse events of short duration for repeated low-frequency EA and no adverse events for physical exercise, a combination of low-frequency EA and physical exercise is recommended for treatment of oligo/amenorrhea in women with PCOS. With an unmet need for assessment and treatment of affective symptoms in women with PCOS further studies are warranted

The Reality of the Nation’s ‎Decline and the Aspired-for ‎Progress

No two persons dispute over the decline of the Arab Nation. Much evidence for that is ‎available, for example loss of the sense of unity, the engagement of Muslims in marginal ‎issues, deficiency of the social system, acceptance of aggression, ideological conquest etc.‎These diseases found some people ready to distance from Islam and doubtful about ‎the sample of man made by its educational, social and local systems. All this is due to ‎the inefficiency of the religious and social sciences that are influenced by foreign ‎ideology We are ready to accept these factors of declines due to the weakness of the political and ‎cultural qualifications in the face of this foreign ideology and its local representatives. What ‎makes things worse is that our political and cultural alternatives are unrealistic.‎Investigating this topic necessitates reviewing the various ideological backgrounds, ‎and identifying the disturbances of efficient thinking. This should be done before any ‎attempt to suggest solutions is mad

An Industry Experiment of Academic Performance and Drop-out in Gamified Distance Education

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A qualitative investigation of the impact of peer to peer online support for women living with Polycystic Ovary Syndrome

Background: Polycystic Ovary Syndrome is a common, chronic condition which affects women living with the condition both physically and psychologically. Social support may be beneficial to sufferers in coping with chronic conditions and the Internet is becoming a common place for accessing social support and information. The aim of this study was to consider the experiences of women living with Polycystic Ovary Syndrome who access and participate in an online support group discussion forum dedicated to issues surrounding this condition. Methods: Fifty participants responded to a series of open-ended questions via an online survey. Results: Thematic analysis revealed a number of empowering and disempowering experiences associated with online support group participation. The empowering processes reported by members of the group included: Connecting with others who understand; Access to information and advice; Interaction with healthcare professionals; Treatment-related decision making; Improved adjustment and management. In terms disempowering processes, only two were described by group participants: Reading about the negative experiences of others and Feeling like an outsider. Conclusions: For women living with Polycystic Ovary Syndrome, participation within an online support group may help to empower them in a range of important ways however, there may be some disempowering consequences

Investigating the effect of intra-operative infiltration with local anaesthesia on the development of chronic postoperative pain after inguinal hernia repair. A randomized placebo controlled triple blinded and group sequential study design [NCT00484731]

<p>Abstract</p> <p>Background</p> <p>Inguinal hernia repair is one of the most frequently performed procedures in Switzerland (15'000/year). The most common complication postoperatively is development of chronic pain in up to 30% of all patients irrespective of the operative technique.</p> <p>Methods/Design</p> <p>264 patients scheduled for an inguinal hernia repair using one of three procedures (Lichtenstein, Barwell and TEP = total extraperitoneal hernioplasty) are being randomly allocated intra-operatively into two groups. Group I patients receive a local injection of 20 ml Carbostesin^®0.25% at the end of the operation according to a standardised procedure. Group II patients get a 20 ml placebo (0.9% Saline) injection. We use pre-filled identically looking syringes for blinded injection, i.e. the patient, the surgeon and the examinator who performs the postoperative clinical follow-ups remain unaware of group allocation. The primary outcome of the study is the occurrence of developing chronic pain (defined as persistent pain at 3 months FU) measured by VAS and Pain Matcher^®device (Cefar Medical AB, Lund, Sweden).</p> <p>The study started on July 2006. In addition to a sample size re-evaluation three interim analyses are planned after 120, 180 and 240 patients had finished their 3-months follow-up to allow for early study termination.</p> <p>Discussion</p> <p>Using a group sequential study design the minimum number of patients are enrolled to reach a valid conclusion before the end of the study.</p> <p>To limit subjectivity, both a VAS and the Pain Matcher^®device are used for the evaluation of pain. This allows us also to compare these two methods and further assess the use of Pain Matcher^®in clinical routine.</p> <p>The occurrence of chronic pain after inguinal hernia repair has been in focus of several clinical studies but the reduction of it has been rarely investigated. We hope to significantly reduce the occurrence of this complication with our investigated intervention.</p> <p>Trial Registration</p> <p>Our trial has been registered at ClinicalTrials.gov. The trial registration number is: [NCT00484731].</p

Participants’ perspectives on mindfulnessbased cognitive therapy for inflammatory bowel disease: a qualitative study nested within a pilot randomised controlled trial

Background: Mindfulness-based interventions have shown to improve depression and anxiety symptoms as well as quality of life in patients with inflammatory bowel disease (IBD). However, little is known about the experiences of this group of patients participating in mindfulness interventions. This paper sets out to explore the perspectives of patients with IBD recruited to a pilot randomised controlled trial (RCT) of mindfulness-based cognitive therapy (MBCT) about the intervention. Methods: In a qualitative study nested within a parallel two-arm pilot RCT of mindfulness-based cognitive therapy for patients with IBD, two focus group interviews (using the same schedule) and a free text postal survey were conducted. Data from both were analysed using thematic analysis. Data and investigator triangulation was performed to enhance confidence in the ensuing findings. Forty-four patients with IBD were recruited to the pilot RCT from gastroenterology outpatient clinics from two Scottish NHS boards. Eighteen of these patients (ten from mindfulness intervention and eight from control group) also completed a postal survey and participated in two focus groups after completing post intervention assessments. Results: The major themes that emerged from the data were the following: perceived benefits of MBCT for IBD, barriers to attending MBCT and expectations about MBCT. Participants identified MBCT as a therapeutic, educational and an inclusive process as key benefits of the intervention. Key barriers included time and travel constraints. Conclusions: This qualitative study has demonstrated the acceptability of MBCT in a group of patients with IBD. Participants saw MBCT as a therapeutic and educational initiative that transformed their relationship with the illness. The inclusive process and shared experience of MBCT alleviated the sense of social isolation commonly associated with IBD. However, time commitment and travel were recognised as a barrier to MBCT which could potentially influence the degree of therapeutic gain from MBCT for some participants. Keywords: Inflammatory bowel disease, Mindfulness, MBCT, Focus groups, Qualitative stud

Only vulnerable adults show change in chronic low-grade inflammation after contemplative mental training: evidence from a randomized clinical trial.

Growing evidence suggests that chronic low-grade inflammation can be reduced through mindfulness-based mental training interventions. However, these results are inconsistent and based on patient populations with heterogeneous conditions. Similar research in healthy adults is lacking. Moreover, common intervention protocols involve varying combinations of different contemplative practices, such that it remains unclear which types of training most effectively influence biomarkers of inflammation. The present study investigated the effect of three distinct 3-month training modules cultivating a) interoception and present-moment focus (Presence), b) socio-affective skills (Affect), or c) socio-cognitive skills (Perspective) on the inflammatory biomarkers interleukin-6 (IL-6) and high sensitive C-reactive protein (hs-CRP) in 298 healthy adults. We observed no group-level effect of training on either biomarker, but trend-level interactions of training type and participant sex. In additionally exploring the influence of participants' baseline inflammation, a selective training effect emerged: Following the Presence module, participants with relatively higher inflammatory load showed stronger reduction in IL-6 on average, and in hs-CRP if they were male. Mindfulness- and attention-based mental practice thus appears most effective when targeting chronic low-grade inflammation in healthy adults, particularly in men. Overall, our data point to a floor effect in the reduction of inflammatory markers through contemplative mental training, suggesting that mental training may be less effective in improving basal biological health outcomes in healthy, low-stressed adults than in vulnerable populations